Researchers reported a minimally invasive right hepatectomy performed in a patient with perihilar cholangiocarcinoma (CCA), as published in Chirurgia (Bucur).
“The goal of providing radical and curative-intent surgical treatment to patients with perihilar CCA has led to the definition of standard requirements to be fulfilled in surgical candidates including: biliary confluence resection combined with major hepatectomy, along with resection of segment 1 and locoregional lymphadenectomy,” the authors wrote.
The case report details a patient who presented with jaundice and underwent radiological staging using computed tomography and magnetic resonance imaging. Preoperative evaluation revealed that the patient’s biliary disease predominantly involved the right hemiliver and the right hepatic artery.
The patient was then referred to the authors of this study following the placement of right external-internal biliary drainage. Upon further evaluation, the surgical team decided that there were no technical contraindications preventing resection.
Read more about CCA treatment
“In order to obtain an adequate oncological radicality, a right hepatectomy extended to segment 1 was planned and performed without the need to induce hypertrophy of the left hemiliver since the future liver remnant had adequate volume and function,” they said.
During the surgery, the surgeons removed lymph nodes of stations 8 and 12. They then loaded the hepatic hilum on an umbilical tape for the Pringle maneuver. After that, they isolated and dissected the main bile duct from its extrapancreatic portion.
The surgeons adopted a primary hilar approach, involving the separate dissection and extraparenchymal isolation of the right portal vein and right hepatic artery. They performed parenchymal transection along the ischemic demarcation line.
“The hilar plate was reached via the transparenchymal route and the bile duct contralateral to the disease (therefore the left) was sectioned and the stump sent for intraoperative frozen section to rule out neoplastic infiltration,” they wrote. Segment 1 was removed, and biliary enteric anastomosis was performed.
The patient’s postoperative hospital stay was 13 days with the final pathological staging being adenocarcinoma with moderate differentiation (G2), pT3 (with vascular and perineural involvement), pN1 (1/13).
Ratti F, Cipriani F, Lee Y, Marino R, Catena M, Aldrighetti L. Minimally-invasive right hepatectomy for perihilar cholangiocarcinoma. Chirurgia (Bucur). Published online November 30, 2021. doi:10.21614/chirurgia.2634